Dorangeon P H, Quereux C, Wahl P
Service de Gynécologie-Obstétrique, CHU, Reims.
Rev Fr Gynecol Obstet. 1989 Dec;84(12):905-13.
In 92,130 pregnancies followed between 1980 and 1987, 48 cases of hyperthyroidism were reported including 38 Grave's diseases, 5 toxic adenomas, 4 multinodules goiters. In comparing the results with those mentioned in the literature, a number of conclusions may be reached. In case of hyperthyroidism treated before the pregnancy or discovered at the beginning, there is, in every other case, an aggravation at the end of the first trimester, then a stabilization in the 2nd or 3rd trimester and finally an aggravation in the post-partum period. There is a high rate of abortions (35 p. cent), a delayed intra-uterine growth in half of the cases. The problem of the treatment is of paramount importance; there is no problem with Beta-blockers but the SAT are not without danger: risk of hypothyroidism and fetal goiter, but also risk of maternal hypothyroidism. From the 15th week, the doses should therefore be decreased, and sometimes the treatment discontinued and replaced with Beta-blockers. The best SAT drug during pregnancy is the propylthioracile which is the least likely to cross the fetal barrier. Surgery is only exceptionally indicated. In a woman who is cured from her Grave's disease, recurrences are always possible, and also fetal hyperthyroidism caused by crossing of thyreostimulins immunoglobins, even in case of maternal euthyroidism.
在1980年至1987年期间追踪的92130例妊娠中，报告了48例甲状腺功能亢进症，其中包括38例格雷夫斯病、5例毒性腺瘤、4例多结节性甲状腺肿。将结果与文献中提及的结果进行比较后，可以得出一些结论。对于在妊娠前接受治疗或妊娠初期发现的甲状腺功能亢进症患者，在其他所有情况下，孕早期结束时病情会加重，然后在孕中期或孕晚期病情稳定，最后在产后病情加重。流产率很高（35%），半数病例存在宫内生长迟缓问题。治疗问题至关重要；使用β受体阻滞剂没有问题，但硫脲类药物并非没有风险：存在甲状腺功能减退和胎儿甲状腺肿的风险，还有母体甲状腺功能减退的风险。因此，从第15周起，应减少剂量，有时应停止治疗，改用β受体阻滞剂。孕期最佳的硫脲类药物是丙硫氧嘧啶，它最不容易穿过胎盘屏障。手术仅在极少数情况下适用。对于已治愈格雷夫斯病的女性，复发总是有可能的，而且即使母体甲状腺功能正常，也可能因促甲状腺素免疫球蛋白穿过胎盘而导致胎儿甲状腺功能亢进。
